- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $2,303.00 / $7,602.00
| Facility | | $750.00 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,486.00 / $9,283.00
| Facility | | $2,056.00 | $5,486.00 | $9,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.32 / $16,394.00 / $19,913.50
| Facility | | $2,233.32 | $16,394.00 | $19,913.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,750.00 / $3,612.00 / $6,285.00
| Facility | | $1,750.00 | $3,612.00 | $6,285.00 |